Ask the Payment Expert about... Quality Measures

Patricia Boyer,  MSM, NHA, RN
Patricia Boyer, MSM, NHA, RN

What are the Quality Measures that will be included in the new SNF Value Based Purchasing program? 

Two existing Quality Measures will be included in the initiative beginning in October of 2016. 

The first is Percent of Residents With Pressure Ulcers That Are New or Worsened (Short Stay). The numerator for this calculation includes all residents with coding indicating one or more new or worsening Stage II-IV pressure ulcers in M0800 of the MDS. 

When the resident is admitted to the facility, it is essential that the skin is assessed within 24 hours and you are identifying any Stage I–IV pressure areas. If any pressure area is missed on the initial assessment and/or it develops or declines after admission, the area will meet the criteria for inclusion in the measure. 

Remember that short-stay measures are for residents in an episode of care from one to 100 days. If the resident goes to the hospital and returns during that timespan, it is critical that you reassess the resident upon readmission and identify any pressure ulcers. 

The second Quality Measure that will be included is Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay). This measure will include any residents who are coded in J1900C as a 1 or a 2.  

This is a long-stay measure, which means the episode of care for this resident is 101 days or more. It is important to make sure your staff is coding J1900 correctly. According to the RAI Manual, Chapter 3, page J-31, a major injury … Includes bone fractures, joint dislocations, closed head injuries with altered consciousness, subdural hematoma. This is an area found to be inaccurately coded frequently, so reeducate your staff in this coding if needed.

These two quality measures are not new and you should be presently tracking them in your CASPER system.